A study of the social causes of over-medication in China

This thesis seeks to examine the root causes of over-medication in China. I have applied Donald Light’s theoretical model of “Countervailing Powers” in the context of socio-economic transition in China, focusing on the important causes of over-medication (over-prescription) in the healthcare system and seeking to explore how the interacting powers of government, the pharmaceutical industry and the medical profession relate to the phenomenon of prescription drug over-use. The study has mainly used documentary and interview research methods. The primary methods of data collection are: 1) a review of documents and literatures obtained from governmental (e.g. MOH report and Year Book of Public Health, etc.) and non-governmental sources, and 2) semi-structured and structured interviews that focus on doctors in Shandong Province. The findings of this thesis suggest that a complex of interactive social relationships in China causes its problem of over-medication. These include insufficient government subsidy for hospitals and doctors, loopholes in the drug pricing policy and regulations, close ties between the pharmaceutical industry and doctors, doctors’ prescribing practice, and the financial incentives involved in drug sales. This thesis is the first study to apply the countervailing powers theory in China’s healthcare context. The study of the interaction between different groups of actors in the healthcare domain provides a novel understanding of the phenomenon of over-medication in China. The findings are expected to contribute to the development of strategies and recommendations that could reduce drug over-use and improve the healthcare system by improving policy design, implementation and evaluation, doctors’ prescribing behaviour and the doctor–patient relationship. The analytical results of this research will also shed some critical light on current global issues concerning the role of the state and effective healthcare policy implementation in the healthcare domain.